National Medicines Policy submission focuses on clinical practice

Morgan Liotta

12/11/2021 4:09:30 PM

Key recommendations for the policy’s review put forward by the RACGP are aimed at ensuring access, safety and quality.

Doctor's Bag
The RACGP has said increased Doctor’s Bag supplies would be needed to support alternative dispensing in future.

Much has changed since Australia’s National Medicines Policy (NMP) was first published in 2000.
To accommodate these changes to the healthcare landscape, the Department of Health commissioned a review that ran from August to October this year and sought feedback aimed at identifying ‘any gaps in the NMP’s objectives, partnership approach and accountabilities’.
In response, the RACGP put forward a submission highlighting the importance of how the policy is implemented and will translate into use in clinical practice.
RACGP representative Clinical Associate Professor Rashmi Sharma told newsGP that as the NMP is a ‘very high-level strategic document,’ it is important to understand that it is not all directly related to general practice at the grassroots level.
‘The objectives [of the NMP] are sound, but it is the application to the clinical space which is the important step, in ensuring access and quality − and also appropriate costs to the health budget,’ she said.
‘Many of the improvements that we see as a profession sit within the principles and objectives of the policy and hence should be considered within this framework.’
Associate Professor Sharma said that as the NMP’s objectives intersect with day-to-day general practice ‘at many levels’ the RACGP supports a review of the policy.
‘Especially with the recent advances in this area and also challenges that have come to light with the pandemic,’ she said.
‘We are hoping that the high-level principles translate into changes on the ground and that the changes that we feel need to be made align with the objectives of the policy.’
Key college recommendations related to the objectives of the policy include:

  • mechanisms and/or mandates implemented to ensure a minimum supply of medication is available in Australia
  • consideration of efficient and cheaper alternatives to community pharmacy dispensing
  • improved post-marketing surveillance
  • clear definition of the term ‘medical devices’, particularly software as a medical device
  • standardisation and quality assurance for supporting tools and software for medical devices
  • prescribing software and medication lists to be fully integrated with residential aged care facility software
  • complementary and alternative medicines included in medicine databases, with more transparency about the benefits and harms to assist with adverse reaction monitoring.
Chair of RACGP Expert Committee – Quality Care Professor Mark Morgan believes the NMP should emphasise reducing supply issues via greater medicines independence for Australia.
‘The scope of NMP should not relate to profitability of pharmacy chains, but should be broad enough to step back and look at the whole system of getting the right medicine to the right person at the right time and for the right price,’ Professor Morgan told newsGP.
The college recommends mechanisms be put in to place to ensure a minimum supply of medication is available to meet demand more effectively, supporting the expansion of Active Script Lists as one such measure.
Exploring possible changes to efficient and cheaper alternatives to community pharmacy dispensing is another important recommendation, according to both Associate Professor Sharma and Professor Morgan, and employing the doctor−patient relationship should also be considered.
‘My own views about alternatives to community pharmacy dispensing come from a position of wanting to make medicines more accessible and cheaper, particularly for patients on stable long-term medications,’ Professor Morgan said.
‘The frequency of medical reviews is best determined by the patient and doctor together, rather than arbitrary monthly supplies of medication.’
Examining the future of dispensing, the proposal of alternatives such as medicine vending machines has been raised outside the college.
‘To support alternative dispensing, a well-resourced “dial-a-pharmacist” advice service would be needed and increased Doctor’s Bag supplies for immediate needs,’ Professor Morgan said.
‘The massive saving from the Community Pharmacy Agreement could be reinvested in general practice.’
Professor Morgan also believes the interaction between patients and pharmacists in the community pharmacy setting should be re-examined, and has previously called for pharmacists to be part of GP-led primary care teams providing medication education for patients and dispensing advice.
‘A lot is said about how [this interaction] adds to quality use of medicines, and particularly patient safety, but anecdotally it is often little more than the interaction between a person and a shopkeeper, in a public place that lacks privacy,’ he said.
‘My thoughts are that highly trained pharmacists would be much better employed within general practice with responsibility for quality use of medicine activities and patient education, where and when helpful.’
Associate Professor Sharma said there needs to be focus on areas of quality use of medicines.
‘The support of integrated, multidisciplinary and collaborative care and systems need to be developed to enable this, for example in the area of aged care, real-time prescription monitoring and real investment into general practice pharmacists,’ she said.
Meanwhile, the RACGP submission also highlights the importance of health literacy among patients, and calls for patient-centred approaches to be evidence-based to ensure quality assurance and patient safety.
‘Patient safety can be enhanced by much better use of real-time computer decision support software with intelligent alerts and prompts that make best use of routinely recorded patient data,’ Professor Morgan said.
Associate Professor Sharma agrees.
‘Working with consumers to improve health literacy with a better understanding of their medications, and also assist them to embrace the rapid digital changes in this space is a priority, with focus on those in vulnerable population groups,’ she said.
At a clinical practice level, Associate Professor Sharma supports the recommendations for improved post-marketing surveillance of medications to be integrated into general practice software, as well as support for consumers to access medication in a variety of ways, including cost and length of supply.
‘[However], a further review of the authority system is needed to further cut the red tape we encounter,’ she said.
‘[The RACGP’s recommendations] should directly relate to the proposed objectives – high-quality management of medicines with the well-informed consumer at the centre, while encouraging innovation and also cost effectiveness – to result in integrated care.’
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